Medicaid Benefits: Online Database

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Acute Care Services

Institutional and Clinic Services

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Products and Devices

Transportation Services

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Long-Term Care Services

Community Based Care

Institutional Care

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Benefits by State: Michigan (October 2008) Notes

Acute Care Services

Is the Benefit Covered?	Copayment Requirement	Prior Approval Requirement	Coverage Limitations	Reimbursement Methodology	Populations Covered

Institutional and Clinic Services
Clinic Services, by an organized facility or clinic not part of a hospital: Freestanding Ambulatory Surgery Center
Yes				Fee for service, using physician reimbursement rates	CN & MN
Clinic Services, by an organized facility or clinic not part of a hospital: Public Health and Mental Health Clinics
Yes	$3/dental visit; $2/physician visit other than for mental health - see state-specific FN			Cost based payment for Public Health Clinics, Mental Health Clinics generally paid capitation rate, Public Dental Clinics paid average commercial rate	CN & MN
Federally Qualified Health Center Services
Yes				Prospective cost based rate/visit	CN & MN
Inpatient Hospital Services, other than in an Institution for Mental Diseases
Yes	$50/first day of admission - see state-specific FN	Elective admissions, readmissions within 15 days, non-emergency transfers		Prospective payment/discharge using DRG, prospective per diem for psych hospitals/units	CN & MN
Outpatient Hospital Services
Yes	$3/non-emergency visit in ER, $1/hospital clinic visit			Fee for service, with surgical procedures grouped using Medicare methodology, satellite clinics in health shortage areas paid higher rates	CN & MN
Rehabilitation Services: Mental Health and Substance Abuse
Yes				Capitation payment	CN & MN
Rural Health Clinic Services
Yes				Cost based payment	CN & MN
Practitioner Services
Certified Registered Nurse Anesthetist Services
Yes		Selected procedures		Fee for service using base units, time and level of supervision	CN & MN
Chiropractor Services
Yes	$1/visit		18 visits/year	Fee for service	CN & MN
Dental Services
Yes	$3/visit		Adult exam and cleaning 2/year, frequency of x-rays limited by type	Fee for service, Public Dental Clinics paid average commercial rate	CN & MN
Medical and Remedial Care - Other Practitioners

Medical/Surgical Services of a Dentist
Yes		Specified services		Fee for service using physician fee schedule	CN & MN
Nurse Midwife Services
Yes	$2/office visit not associated with pregnancy or family planning			Fee for service	CN & MN
Nurse Practitioner Services
Yes	$2/office visit not associated with pregnancy or family planning	Selected procedures		Fee for service	CN & MN
Optometrist Services
Yes	$2/visit		1 refractive exam/2 years	Fee for service	CN & MN
Physician Services
Yes	$2/visit - see state-specific FN	Selected procedures	10 psychiatric visits/year	Fee for service	CN & MN
Podiatrist Services
Yes	$2/visit	Selected procedures	Routine foot care not covered	Fee for service	CN & MN
Psychologist Services
No
Prescription Drugs
Prescription Drugs
Yes	$1/generic Rx, $3/brand Rx			AWP-13.5% for independent pharmacies, AWP-15.1% for chain stores, plus $2.50 dispensing fee for each, non-traditional pharmacies paid $2.75 dispensing fee	CN & MN
Physical Therapy and Other Services
Occupational Therapy Services
No
Physical Therapy Services
No
Services for Speech, Hearing and Language Disorders
No
Products and Devices
Dentures
Yes	$3/denture	Yes	1 full upper and/or lower denture or 1 partial/5 years	Fee for service, Public Dental Clinics paid average commercial rate	CN & MN
Eyeglasses
Yes	$2/dispensing service	Selected procedures	1 pair eyeglasses/2 years, minimum diopter correction required for initial and replacement eyeglasses, replacements within 2 years only if eyeglasses lost or unusable, contact lenses and special lenses for specified medical conditions, oversized and progressive or transition lenses not covered	Most products, excluding contact lenses, provided by state's volume purchase contractor, dispensing provider paid fee for service	CN & MN
Hearing Aids
Yes	$3/hearing aid	Specified services and items including alternative listening devices	1 hearing aid/3 years	Fee for service or authorized amount	CN & MN
Medical Equipment and Supplies
Yes		Specified med equipment and med supply items	Limitations vary by type of equipment o supply	Fee for service for most products, incontinence supplies available through state's volume purchase contractor	CN & MN
Prosthetic and Orthotic Devices
Yes		Specified services or items		Fee for service	CN & MN
Transportation Services
Ambulance Services
Yes		Fixed wing transport		Fee for service	CN & MN
Non-Emergency Medical Transportation Services
Yes				See service-specific FN	CN & MN
Other Services
Diagnostic, Screening and Preventive Services
No
Early and Periodic Screening, Diagnosis and Treatment
See service-specific FN.
Extended Services for Pregnant Women

Family Planning Services
See service-specific FN.
Laboratory and X-Ray Services, outside Hospital or Clinic
Yes		Selected services		Fee for service	CN & MN
Targeted Case Management
Yes				Fee for service or capitated rate	CN & MN

Long-Term Care Services


Community Based Care
Home and Community Based Services Waiver
Yes		Services for the following populations: 1, 2, 4, 6 & 8 - See service-specific FN	Dependent upon the services provided	CN & MN
Home Health Services, includes nursing services, home health aides, and medical supplies/equipment
Yes			Fee for service	CN & MN
Hospice Care
Yes			Prospective rates based on Medicare methodology	CN & MN
Personal Care Services
Yes			Fee for service using hourly rates adjusted for LOC	CN & MN
Private Duty Nursing Services
No
Program of All-Inclusive Care for the Elderly
Yes		See service-specific FN	Capitated payment	CN & MN
Institutional Care
Inpatient Hospital, Nursing Facility and Intermediate Care Facility Services In Institutions for Mental Diseases, age 65 and older
Yes			Prospective cost based per diem for public facilities, private facility reimbursement determined by contracted PIHPs	CN & MN
Inpatient Psychiatric Services, under age 21
Yes			Prospective cost based per diem for public facilities, private facility reimbursement determined by contracted PIHPs	CN & MN
Intermediate Care Facility Services for the Mentally Retarded
Yes			Prospective cost based per diem fwith limits	CN & MN
Nursing Facility Services, other than in an Institution for Mental Diseases
Yes	Therapies and customized med equipment	10 hosp leave days/year, 18 therapeutic leave days/year	Prospective per diem based on cost with limits, reduced per diem paid for hospital leave days and only if 98% occupancy requirement met	CN & MN
Religious Non-Medical Health Care Institution and Practitioner Services
No

Notes: This State has added the optional Medicaid buy-in group of disabled adults permissible through the Ticket to Work and Work Incentives Improvement Act (TWWIIA) in a program called Freedom to Work. These beneficiaries are allowed to continue Medicaid coverage, and receive full benefits, if their income is at or below 250 percent of the federal poverty level (FPL). Beneficiaries in this group with annual income between 250 percent of the FPL and $75,000 pay an income-based monthly premium. The inpatient hospital copayment requirement does not apply to second hospitals receiving a transfer or to readmissions within 15 days of discharge for the same DRG/diagnosis. The physician copayment requirement is limited to specific office visit codes.